Boron neutron capture therapy for malignant melanoma: first clinical case report in China

Abstract

A phase I/II clinical trial for treating malignant melanoma by boron neutron capture therapy (BNCT) was designed to evaluate whether the world’s first in-hospital neutron irradiator (IHNI) was qualified for BNCT. In this clinical trial planning to enroll 30 patients, the first case was treated on August 19, 2014. We present the protocol of this clinical trial, the treating procedure, and the clinical outcome of this first case. Only grade 2 acute radiation injury was observed during the first four weeks after BNCT and the injury healed after treatment. No late radiation injury was found during the 24-month follow-up. Based on positron emission tomography-computed tomography (PET/CT) scan, pathological analysis and gross examination, the patient showed a complete response to BNCT, indicating that BNCT is a potent therapy against malignant melanoma and IHNI has the potential to enable the delivery of BNCT in hospitals.

Boron Chemistry for Medical Applications

“…Two other patients, one with multiple metastatic cutaneous nodules on the right leg and the other with acral lentiginpus subungal melanoma of the right thumb, showed partial response [122] as per the Japanese clinical results in treating the cutaneous melanomas patients using BNCT. Hiratsuka et al [60] reported four patients with genital malignancies, who were treated with BNCT and the patients included three with genital extramammary Paget's disease (EMPD) and one patient with vulvar melanoma (VM).…”

“…Similar results were observed by Finnish and Japanese clinicians, who also treated the recurrent HN tumor patients. The resulting recurrence after treatment with BNCT might be due to the poor microdistribution of BPA-F in some region of the tumor, such as non-homogenous uptake of BPA-F by the tumor cells [30,122].…”

“…Out of these three patients, one has acral melanoma on the sole of his foot who had declined surgery (as indicated in Figure 10). Yong et al [122] reported that grade-II acute radiation injury was observed during the first four weeks after BNCT and was healed after treatment. No late radiation injury was found during the 24-month follow-up.…”

“…Gross examination of the skin lesions in the patient's left foot 2 weeks (A), 5 weeks (B) and 24 months (C) after BNCT; (D) Pathological analysis after BNCT; (E) PET/CT scan after BNCT (reprint from Ref [122]…”

Radiobiological response of U251MG, CHO-K1 and V79 cell lines to accelerator-based boron neutron capture therapy

“…Thus, BNCT, in its ideal application, can provide curative treatment for invasive cancers, such as glioblastoma. The efficacy of BNCT from a nuclear reactor neutron source has been confirmed for certain malignancies, including glioma [ 2 – 4 ], malignant melanoma [ 5 ], and head and neck cancer [ 6 – 9 ]. However, safety issues, as well as the negative publicity surrounding the Fukushima accident, turned the world BNCT community towards development of accelerator-based neutron sources to replace nuclear reactors in both trials and therapy.…”